Provider Demographics
NPI:1982227799
Name:BRINDLEY, MACKENZIE L (DMD)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:L
Last Name:BRINDLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N WAUKEGAN RD STE 1200
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1686
Mailing Address - Country:US
Mailing Address - Phone:847-234-4405
Mailing Address - Fax:
Practice Address - Street 1:101 N WAUKEGAN RD STE 1200
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1686
Practice Address - Country:US
Practice Address - Phone:847-243-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10435122300000X
IL019.034251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist